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Eugenics  as  a  Factor  in 
the  Prevention  of  Mental 
Disease 


of  Califori 
Q  Regional] 
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THE  LIBRARY 
OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


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Eugenics  as  a  Factor  in  the  Pre- 
vention of  Mental  Disease 

4 


By 
HORATIO   M.   POLLOCK,  Ph.D. 

Statistician,  New  York  State  Hospital  Commission 


'   Of-    CALll-Or 
LiaRARY, 
3  /^rs»c3ELes,  Q^JF. 


^  r^-R  ^  '^ 


THE  NATIONAL  COMMITTEE  FOR 

MENTAL  HYGIENE,  Inc. 

370  Seventh  Avenue 

New  York  City 

1921 


The  National  Committee  for  Mental  Hygiene 

Founded  1909  Incorpobated  1916 

370  SEVENTH  AVENUE,  NEW  YORK  CITY 


Db. 


President 
Walter  B,  James 


Tice-P7-eside7its 
Charles  W.  Eliot 
Db.  Bernard  Sachs 
Dr.  William  H.  Welch 

Treasurer 
Otto  T.  Bannaed 


Committee  on  Mental  Deficiency 
Db.  Walter  E.  Fernald,  Chairman 


Executive  Committee 
Dr.  William  L.  Russell,  Chairman 
Dr.  Owen  Copp 
Stephen  P.  Dugqan 
Dr.  Walter  E.  Fernald 
Matthew  C.  Fleming 
Dr.  Walter  B.  James 
Dr.  George  H.  Kirby 


Committee  on  Education 
Dr.  C.  Macfie  Campbell,  Chairman 

Edith  M.  Fubbush,  Statistician 


Executive  Officers 

Dr.  Thomas  W.  Salmon,  Medical  Director 

Db.  Frankwood  E.  Williams,  Associate  Medical  Director 

Dr.  V.  V.  Anderson,  Associate  Medical  Director 

Dr.  Clarence  J.  D 'Alton,  Executive  Assistant 

Clifford  W.  Beebs,  Secretary 


GENERAL  PURPOSES 

The  National  Committee  for  Mental  Hygiene  and  its  affiliated  state  societies 
and  committees  are  organized  to  work  for  the  conservation  of  mental  health; 
to  help  prevent  nervous  and  mental  disorders  and  mental  defect ;  to  help  raise  the 
standards  of  care  and  treatment  for  those  suffering  from  any  of  these  disorders 
or  mental  defect;  to  secure  and  disseminate  reliable  information  on  these  sub- 
jects and  also  on  mental  factors  involved  in  problems  related  to  industry,  educa- 
tion, delinquency,  dependency,  and  the  like;  to  aid  c^-service  men  disabled  in 
the  •war,  to  cooperate  with  federal,  state,  and  local  agencies  and  with  officials 
and  with  public  and  private  agencies  whose  work  is  in  any  way  related  to  that 
of  a  society  or  committee  for  mental  hygiene.  Though  methods  vary,  these  or- 
ganizations seek  to  accomplish  their  purposes  by  means  of  education,  encouraging 
psychiatric  social  service,  conducting  surveys,  promoting  legislation,  and  through 
cooperation  with  the  many  agencies  whose  work  touches  at  one  point  or  another 
the  field  of  mental  hygiene. 

When  one  considers  the  large  groups  of  people  who  may  be  benefited  by  or- 
ganized work  in  mental  hygiene,  the  importance  of  the  movement  at  once  becomes 
apparent.  Such  work  is  not  only  for  the  mentally  disordered  and  those  suffer- 
ing from  mental  defect,  but  for  all  those  who,  through  mental  causes,  are  unable 
so  to  adjust  themselves  to  their  environment  as  to  live  happy  and  efficient  lives. 


[Reprinted  from  Mental  Hygiene,  Vol.  V,  No.  4,  October,  1921,  pp.  807-812.] 


n5S 

EUGENICS  AS  A.  FACTOR  IN  THE  PRE- 
^  VENTION  OF  MENTAL  DISEASE* 

HORATIO  M.  POLLOCK,  Ph.D. 

^^^  Statistician,  New  ¥ork  State  Hospital  Commission 

\ 

*"  nnHE   burden   of  mental  disease   is   each  year   becoming 

J  -*-     heavier.    State  hospitals  for  mental  disease  throughout 

^  the  country  are  overcrowded,  and  the  construction  of  new 

hospitals  does  not  keep  pace  with  the  increase  of  patients. 

Fairly  complete  censuses  show  that  the  number  of  patients 

with  mental  disease  under  treatment  in  institutions  increased 

from  74,028  in  1890  to  232,680  in  1920.    The  rate  per  100,000 

of  population  increased  from  118.2  to  220.1.     Careful  esti- 

'^  mates  based  on  statistics  of  the  New  York  State  Hospital 

v>.  Commission  indicate  that  approximately  1  out  of  25  persons 

^»vbecomes  insane  at  some  period  of  life.    The  economic  loss  to 

the  United  States  on  account  of  mental  disease,  including 

loss  of  earnings  as  well  as  maintenance  of  patients,  is  now 

over  $200,000,000  per  year.    Although  much  of  the  apparent 

V.  increase  in  the  prevalence  of  mental  disease  may  be  due  to 

V   causes  that  do  not  involve  weakened  resistance  to  the  stresses 

of  life,  the  load  born  by  the  public  is  clearly  becoming  more 

oppressive. 

Associated  burdens  are  those  of  mental  defect,  epilepsy, 

.  dependency,    and   delinquency.     These    combined    cause    an 

1  economic  loss  even  greater  than  that  caused  by  mental  dis- 

^  ease. 

Taxpayers  are  groaning  under  excessive  loads  and  calling 
in  vain  for  relief,  but  their  cries  are  faint  compared  with 
those  of  the  persons  whose  relatives  are  mentally  diseased  or 
defective. 

As  less  than  one-fourth  of  those  who  develop  psychoses 
can  be  cured  by  present  methods  of  treatment,  we  cannot 
hope  for  any  permanent  relief  by  treating  patients  in  hos- 
pitals.   The  most  skillful  treatment  should  of  course  be  given, 

*  Read  before  the  Section  on  Eugenics  and  the  State  of  the  Second  International 
Eugenics  Congress,  New  York  City,  September  26,  1921. 

1 


2  THE  PREVENTION  OF  MENTAL  DISEASE 

but  the  problem  must  be  attacked  in  other  ways  before  any- 
adequate  solution  can  be  hoped  for. 

The  fact  of  inheritance  of  the  neuropathic  constitution  may 
be  taken  for  granted.  Much  evidence  has  been  adduced  to 
prove  that  such  inheritance  occurs  in  accordance  with  Mende- 
lian  laws,  but  the  subject  is  so  complicated  that  more  com- 
prehensive studies  must  be  made  before  we  may  consider  the 
matter  as  settled.  The  application  of  skillfully  devised 
measures  of  intelligence  has  shown  us  that  there  are  many 
grades  of  intelligence  between  the  idiot  and  the  super-aver- 
age. The  so-called  normals  represent  many  types,  the  ex- 
tremes of  which  are  as  far  apart  as  the  moron  is  from  the 
low-grade  normal.  Recent  studies  of  temperamental  abnorm- 
alities have  also  revealed  a  wide  variety  of  types  and  com- 
binations. These  abnormalities  or  marked  peculiarities  seem 
to  be  more  or  less  dissociated  from  intellectual  capacity. 
Children  with  super-average  intelligence  are  frequently 
seclusive  and  morons  often  seem  to  be  temperamentally 
normal.  It  becomes  difficult,  therefore,  to  establish  standards 
of  normality  and  to  draw  fixed  lines  between  the  normal  and 
the  neuropathic.  This  is  especially  true  in  studying  family 
histories,  when  judgment  must  be  based  on  reports  of  un- 
trained observers.  Mental  disease  may  occur  in  a  person  of 
almost  any  type  of  intellectual  or  temperamental  make-up. 
This  fact  was  clearly  demonstrated  during  the  recent  World 
War.  Men  of  strong  intellect  and  of  exceptional  poise  who 
had  withstood  the  strain  of  intense  warfare  for  several 
months  at  last  succumbed  when  weakened  by  wounds  and 
deprivation  of  food  and  drink.  These  were  extreme  cases, 
but  they  illustrate  the  important  principle  that  all  men  have 
limitations  and  may  develop  a  psychosis  or  expire  when  their 
limit  is  reached.  Psychopathic  personalities  give  way  to  the 
common  stresses  of  life,  while  stronger  personalities  yield 
only  to  extraordinary  mental  strain.  It  is  evident,  therefore, 
that  the  whole  etiology  of  a  case  of  mental  disease  must  be 
carefully  studied  before  the  related  family  stock  can  be  safely 
discredited. 

The  data  we  have  collected  in  the  New  York  State  Hos- 
pital Commission  relative  to  the  family  history  of  patients 
seem  to  indicate  that  slightly  more  than  half  of  our  ascer- 


THE  PREVENTION  OF  MENTAL  DISEASE  3 

tained  cases  have  no  discoverable  hereditary  basis.  If  more 
thorough  inquiries  were  made,  the  proportion  of  patients 
with  unfavorable  family  history  might  be  increased,  but  the 
significance  of  the  history  in  relation  to  the  family  stock  is 
open  to  question  in  many  cases. 

In  our  hospitals  for  some  years  past,  we  have  studied  both 
the  intellectual  and  temperamental  make-up  of  the  first  ad- 
missions and  have  tried  to  apply  imiform  standards  through- 
out the  service.  In  1920  it  was  found  that  of  the  ascertained 
cases  61  per  cent  were  temperamentally  normal  and  88  per 
cent  were  rated  as  intellectually  normal.  Only  about  7  per 
cent  of  the  patients  were  both  temperamentally  and  intellectu- 
ally abnormal.  The  proportion  of  patients  mth  abnormal 
make-up  varied  considerably  in  the  different  groups  of  psy- 
choses. For  example,  in  the  dementia-praecox  group  in  1920, 
61  per  cent  were  rated  as  temperamentally  abnormal  while  in 
the  manic-depressive  group  only  33  per  cent  were  so  rated. 

The  absence  of  marked  abnormalities  in  individuals  prior 
to  the  onset  of  the  psychosis  cannot  be  construed  as  conclu- 
sive evidence  that  there  are  no  hereditary  defects  in  the 
make-up,  neither  can  the  development  of  the  psychosis  be 
taken  as  proof  of  a  defective  constitution.  All  the  facts  in 
connection  with  the  onset  of  the  mental  disorder  and  previous 
reactions  must  be  brought  together  before  the  constitutional 
make-up  of  the  patient  can  be  positively  determined. 

Psychiatrists  have  recently  emphasized  the  connection 
between  bodily  states  and  behavior  and  the  importance  of  the 
sexual  and  endocrine  organs  in  relation  to  the  psychoses. 
What  part  of  the  disorders  related  to  these  organs  is  due  to 
hereditary  and  what  part  to  environmental  factors  have  yet 
to  be  determined. 

Notwithstanding  these  and  many  other  complications, 
there  is  abundant  evidence  that  mental  disorders  occur  much 
more  frequently  in  some  family  stocks  than  in  others,  and 
that  prolonged  inbreeding  of  degenerate  stocks  is  productive 
of  most  disastrous  results. 

With  the  limited  knowledge  at  hand,  what  is  to  be  done  to 
lessen  the  burdens  imposed  on  society  by  the  prevalence  of 
mental  disease? 

Three  lines  of  action  are  suggested : 


4  THE  PREVENTION  OF  MENTAL  DISEASE 

1.  Environmental  stresses  may  be  lessened  and  natural 
resistance  strengthened. 

2.  Procreation  of  defective  stock  may  be  checked. 

3.  Procreation  of  normal  stock  may  be  increased. 

The  methods  now  in  nse  to  prevent  physical  disease  may  be 
applied  to  a  considerable  extent  in  preventing  mental  disease. 
They  include  the  dissemination  of  knowledge  of  hygiene  and 
sanitation,  prompt  treatment  of  incipient  diseases,  segrega- 
tion of  those  suffering  from  contagious  diseases,  and  im- 
munization of  those  liable  to  exposure  to  pathogenic  germs. 
Another  line  of  attack  consists  in  safeguarding  the  public 
from  injurious  food  and  artificial  beverages  and  from  pol- 
luted air  and  water.  The  abolition  of  the  liquor  traffic  and 
the  movement  to  check  the  spread  of  syphilis  are  examples 
of  effective  work  along  these  lines. 

Economic  and  social  stresses  should  be  lightened  for  those 
unable  to  withstand  them.  It  is  far  easier  to  relieve  an  over- 
burdened man  by  taking  part  of  his  load  than  to  wait  until 
he  is  exhausted  and  then  carry  him  together  with  his  burden. 
Physicians,  parents,  and  teachers  should  be  alert  to  detect 
signs  of  mental  disorder  and  apply  the  proper  remedy  before 
complete  breakdown  occurs. 

Mental  clinics  and  social  workers  are  of  large  service  in 
giving  treatment  in  incipient  cases.  Many  a  case  of  mental 
disease  is  averted  by  adjusting  the  environment  to  the  indi- 
vidual and  by  giving  him  a  clear  understanding  of  his  mental 
difficulties  and  the  best  methods  of  meeting  them.  Wide  ex- 
tension of  mental-clinic  work  is  clearly  indicated. 

The  new  science  of  mental  hygiene  is  teaching  us  that  indi- 
viduals with  unfavorable  heredity  may  do  much  to  overcome 
their  constitutional  tendencies  and  to  preserve  their  mental 
health.  It  is  of  the  highest  importance,  therefore,  that  mental 
hygiene  be  taught  and  practiced  in  the  public  schools  along 
with  physical  hygiene. 

A  decade  ago  sterilization  of  defectives  was  widely  advo- 
cated and  laws  making  provision  for  it  v/ere  passed  in  several 
states.  These  measures  have  availed  little  because  they  have 
not  been  supported  by  active  public  sentiment.  Judging  frona 
the  present  outlook,  we  cannot  hope  that  sterilization  will 
soon  be  an  effective  means  of  preventing  mental  disease. 


THE  PREVENTION  OF  MENTAL  DISEASE  5 

Segregation  of  the  mentally  defective  and  epileptic  is  the 
prevailing  method  of  limiting  procreation  among  these 
classes.  Its  eugenic  value  is  beyond  question,  but  the  enor- 
mous cost  limits  its  application.  As  a  rule  the  mental  de- 
fectives and  epileptics  cared  for  in  institutions  are  of  low 
grade.  These,  if  left  at  liberty,  would  multiply  far  less  than 
those  of  higher  grade.  Much  is  to  be  hoped  from  the  colony 
plan  of  segregating  mental  defectives,  as  colonies  care  for 
high-grade  defectives  and  under  wise  management  become 
self-supporting  and  may  be  increased  wn^thout  limit. 

A  new  departure  has  been  made  by  the  state  of  New  York 
in  establishing  a  separate  institution  for  defective  delin- 
quents at  Napanoch.  This  troublesome  group  has  been  a 
serious  problem  in  the  jails  and  prisons  of  the  state,  and 
heretofore  there  has  been  no  satisfactory  way  of  dealing  with 
them.  Their  segregation  should  have  large  eugenic  signifi- 
cance. 

Segregation  of  the  insane  is  fairly  complete,  but  as  only 
about  one-fourth  of  the  first  admissions  are  under  thirty 
years  of  age  on  admission,  its  value  in  preventing  procreation 
in  this  group  is  not  as  great  as  would  appear  when  only  the 
number  of  patients  under  treatment  is  considered.  Over- 
crowding and  the  expense  of  maintenance  cause  patients  to 
be  promptly  released  on  improvement  of  their  mental  condi- 
tion, regardless  of  the  eugenic  factors  involved. 

Something  can  be  done  to  lessen  reproduction  among  the 
unfit  by  enlightened  public  sentiment  and  by  better  marriage 
laws.  Marriage  of  persons  with  marked  intellectual  or  tem- 
peramental abnormalities  should  be  entirely  prohibited. 

To  prevent  the  marriage  of  normal  persons  with  those 
carrying  a  neuropathic  taint  more  knowledge  of  family  stocks 
must  be  made  available.  At  the  present  time  genealogical 
records  of  the  average  family  are  woefully  meager  and  com- 
paratively few  are  available  for  public  inspection.  If  we  are 
to  improve  the  race  by  better  marriages,  genealogical  or 
eugenic  bureaus  must  be  established  in  cities  and  villages. 
Data  concerning  family  stocks  should  show  the  defects  as 
well  as  the  excellencies  and  achievements  of  the  individuals 
recorded  and  be  available  to  interested  parties. 

Love  is  proverbially  blind,  but  few  normal  persons  would 


6  THE  PREVENTION  OF  MENTAL  DISEASE 

be  rash  enough  knoAvingly  to  join  fortunes  with  a  neuro- 
pathic or  degenerate  family  stock.  Unfortunately  very  little 
thought  is  now  given  to  the  eugenic  significance  of  marriage 
and  few  signs  warn  impetuous  youth  of  the  danger  ahead. 

Eugenic  bureaus,  by  collecting  data  concerning  family  his- 
tories and  by  emphasizing  the  importance  of  family  stock, 
would  naturally  promote  marriages  among  persons  of  good 
stock  and  thereby  increase  procreation  of  a  desirable  kind. 
The  increase  of  good  stock  would  raise  the  general  level  of 
the  race,  even  if  there  were  no  decrease  of  poor  stock,  but  we 
may  safely  assume  that  more  definite  knowledge  would 
graduallj'^  lessen  reproduction  among  the  unfit. 

The  elimination  of  mental  defects  and  diseases  is  after  all 
principally  a  matter  of  education.  "We  must  learn  by  careful 
research  what  should  be  done  and  what  should  not  be  done 
and  then  disseminate  the  information  so  that  it  will  be 
shared  by  every  household.  Action  will  slowly  follow  knowl- 
edge, but  ultimately  a  more  perfect  race  will  be  evolved. 

65883 


MENTAL  HYGIENE 

QUARTERLY    MAGAZINE    OF 

THE  NATIONAL  COMMITTEE  FOR  MENTAL  HYGIENE,  INC. 

Publication  Office  :  Editobial  Office  : 

27  COLUMBIA  STREET,  ALBANY.  N.  Y.       370  SEVENTH  AVENUE,  NEW  YORK  CITY 


EDITORIAL  BOARD 

Thomas  W.  Salmon,  M.D.,  Medical  Director,  The  National  Committee  for  Metital  Hygiene 

Frankwood  B.  Williams,  M.D., Associate  Medical  Director,  The  National  Committee  }or  Mental  Hygiene 

Walteb   E.   Feenald,   M.D.,   Superintendent,   Massachusetts   School   for  Feeble-minded 

C.  Macfie  Campbell,  Director,   Boston  Psychopathic  Hospital 

Stiuphen  p.  Duggan,  Ph.D.,  Professor  of  Education,  College  of  the  City  of  Neiv  York 

Stewart   Paton,   M.D.,   Lecturer  in   Neuro-hiology,  Princeton   University 

Vol.  V,  No.  4                                                             INDEX                                                             October,  1921 

The  Significance  of  the  Conditioned  Reflex  in  Mental  Hygiene William  H.  Burnhani  673 

The  Elementary  School  and  the  Individual  Child Esther  Loring  Richards  707 

Extra-Medical  Service  in  the  Management  of  Misconduct  Problems  in  Children 

Marion  E.   Kenworthy  724 

Mental   Hygiene  and   the  College   Student — Twenty   Years   After Anonymous  7oG 

Mental    Hygiene   Problems    of    Normal    Adolescence Jessie    Taft  741 

Suicide  in    Massachusetts Albert    Warren   Steams  752 

The  Function  of  the  Correctional  Institution Herman  M.  Adlcr  778 

What  is  a  "Nervous   Breakdown"  ? Alice  E.  Johnson  784 

Mental  Hygiene  and  the  Public  Library Mary   Vida   Clark  791 

Inadequate   Social   Examinations  in   Psychopathic   Clinics Dorothy   Q.   Hale  794 

Eugenics  as  a  Factor  in  the  Prevention  of  Mental  Disease Horatio  M.  Pollock  807 

Mental  Hygiene  Problems  of  Maladjusted  Children  As  Seen  in  a  Public  Clinic.  .  .A.  L.  Jacoby  813 

Speech   Defects   In    School   Children Smiley   Blanton  820 

Extra-Institutional  Care  of  Mental  Defectives Earl   W.   Fuller  828 

Abnormal    Psychology    Barrington    Oates  836 

Abstracts : 

The  Problem  of  a  Psychopathic  Hospital  Connected  with  a  Reformatory  Institution.     By 

Edith   R.    Spaulding 83T 

A    Psychological    Study    of    Some    Mental    Defects    in    the    Normal    Dull    Adolescent.      By 

L.  Pierce  Clark 840 

The  Social  Worker's  Approach  to  the  Family  of  the  Syphilitic.     By  Maida  H.  Solomon.  .  .  .  84;; 
Some  Practical  Points  in  the  Organization  of  Treatment  of  Syphilis  In  a   State  Hospital. 

By  Aaron  J.  RosanoflP 844 

The  Mental   Clinic   and   the  Community.      By   Everett   S.    Elwood 845 

An  Analysis  of  Suicidal  Attempts.     By  Lawson   G.  Lowrey 846 

Book  Reviews  : 

Psychopathology.      By    Edward    J.    Kempf Bernard    Olueck  848 

The  Unconscious.     By  Aforton  Prince William  A.   White  840 

A  General  Introduction  to  Psychoanalysis.     By  Sigmund  Freud Bernard  Olueck  851 

Sleepwalking  and  Moon  Walking.     B.   J.   Sadger O.  Macfie   Campbell  851 

From   the  Unconscious  to  the  Conscious.      By   Gustave   Geley William   A.    White  85r> 

Suggestion   and    Auto-Suggestion.      By    Charles    Baudouin Bernard    Olueck  856 

Psychology   and    Psvcliotherapy.      By   William    Brown C.   Macfie   Campbell  857 

Our  Social  Heritage.     By  Graham   Wallas Miriam  C.  Gould  858 

August  Strindberg :      A   Psychoanalytic   Study  with    Special  Reference  to 

the  CEkiipus  Complex.     By  Axel  Johan  Uppvall Frankwopd  E.   Williams  861 

Notes  and  Comments 878 

Current   Bibliography Dorothy    E.    Morrison  891 

Directory  of  Committees  and   Societies   for   Mental    Hygiene 894 

Members  and  Directors  of  the  National  Committee  for  Mental  Hygiene 895 

Mental  Hygiene  will  aim  to  bring  dependable  information  to  everyone  whose  interest  or  whose 
work  brings  him  into  contact  with  mental  problems.  Writers  of  authority  will  present  original 
communications  and  reviews  of  Important  books  ;  noteworthy  articles  in  periodicals  out  of  convenient 
reach  of  the  general  public  will  be  republished  ;  reports  of  surveys,  special  investigations,  and  new 
methods  of  prevention  or  treatment  in  tlie  broad  field  of  mental  hygiene  and  psychopatliology  will 
bo  presented  and  discussed  in  as  non-technical  a  way  as  possible.  It  is  our  aim  to  make  Mental 
IIYGIENB  Indispensable  to  all  thoughtful  readers.  Physicians,  lawyers,  educators,  clergymen,  publl<' 
officials,  and  students  of  social  problems  will  find  the  magazine  of  especial  interest. 

TTie  National  Committee  for  Mental  Hygiene  does  not  necessarily  endorse  or  assume  responsi- 
bility for  opinions  expressed  or  statements  made.  Articles  presented  are  printed  upon  the  autliorlty 
of  their  writers.  The  reviewing  of  a  book  does  not  imply  its  recommendation  by  The  NatlonnI 
<^ommlttee  for  Mental  Hygiene.  Though  all  articles  in  this  magazine  are  copyrighted,  others  may 
quote  from  them  freely  provided  appropriate  credit  be  given  to  Mental   Hygiene, 

Subscription  :  Two  dollars  a  year  ;  fifty  cents  a  single  copy.  Publication  Office:  27  COLUMBIA 
ST.,  ALBANY,  N.  Y.  Correspondence  sliould  be  addressed  and  checks  made  payable  to  "Mental 
Hygiene,"  27  Columbia  St.,  Albany,  N.  Y.,  or  to  The  National  Committee  for  Mental  Hy^ene,  Inc., 
.no  Seventh  Avenue,  New  York  City. 

Copyright,   1918,  by  the  National  Committee  for  Mental   Hygiene,  Inc. 


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